“We can’t talk openly. We can’t ask for advice or a correct diagnosis that is specific to us. We “They give space; they listen; you can be honest. As opposed to a government facility where can’t ask for information about transmission of infections between women having sex with you get arrested.” other women. They start preaching. They act as pastors. They lecture us.” “These people have improved. They are offering a service at a stage where they are still “As WSWs our statistics are not included in their data. If we come there as women who are being sensitised.” ‘KPs’ we are automatically entered as sex workers. They can classify only as ‘MSM’ or ‘SW male’ or ‘SW female’. They never talk about ‘WSW’”. “Long time back it was very difficult. These people are starting to know us. There’s space now to disclose more openly, although that’s not how it is with all the counsellors. They used “When we went [to PSI Bulawayo] we realised there’s a questionnaire you fill in. But it’s to say things, ask awkward questions, insist on us bringing our partners. Now it’s different; discriminatory. It just makes the assumption that you are in a heterosexual relationship.” it’s at least better.” “Pre-test counselling [at PSI] is usually done in a group. So when you come as a couple This perspective on acceptability amongst gay and bisexual men, although encouraging, there’s a lack of privacy to talk about things as a couple. They call it counselling, but it’s is markedly different from the experience of lesbian and bisexual women, or trans people. mostly just education before you take the test. There’s nothing for psychosocial support. But Reflections across these populations were notably similar whether in Bulawayo or in Harare. coming to test as a couple needs that kind of support. A lesbian couple usually comes for One fundamental issue lay at the core of the acceptability analysis by women and trans testing because there’s been an issue of trust, like if one of them has been cheating with a people: affirmation; that their sexuality and gender identities were recognised and validated. man. This needs support.” Too often, however, these populations felt they were misunderstood, misgendered, misclassified (trans women considered as gay men; non- heterosexual women captured “No one has really taken the time to understand in what way we are affected by HIV. We statistically as sex workers), their sexualities and gender invisibilised or delegitimised within as women. How do we protect our woman partners from HIV? Women are the group most a system of care still biased towards heteronormativity and maleness. And within that affected by HIV, but as lesbian or bisexual women we have no means to protect our partners. analysis, the intersections between acceptability and availability of services for women and People assume there is no transmission between two women. Why then do we get STIs?” trans people are powerfully highlighted. “As soon as you mention your sexuality, the health workers start scratching each other’s arms to get their attention. Rolling their eyes in our direction. Like to say ‘these are those Amongst lesbian and bisexual women (and trans men): ones’”. “I can get many other services – many other general services that are available for other “For me, a good health service means being listened to. So, when I go for treatment for an women – but not specific to my needs as a lesbian woman. Like partner treatment and STI and I’m asked ‘where’s your partner?’ They ask for that because I am a woman; they end counselling. I can’t bring my lesbian partner. Or my partner if I am a trans man. Then all up blaming you for having that STI. And they assume your partner is a man. It’s like that in the questions start, and we can’t be counselled together. We have to be in separate rooms the questionnaire.” because we’re not recognised as a couple.” As has been noted earlier in this report, some of these reflections may or may not be factually “Full disclosure is not an option; I can’t say everything about myself. I fear the discrimination accurate, or they may be; most likely a combination of both. It may well be that health care and judgement. We have to create a back-story or lie about how we got a condition; find providers are especially stigmatising of women, consciously or not. Or it may be that service some way to explain it with a hetero- narrative.” users are not well-enough informed about why certain questions are being asked in the course of taking a patient history, so they experience them as being arbitrary and invasive. PERCEPTIONS, PERSPECTIVES Access to facility-based health services for LGBT people in Harare & Bulawayo, Zimbabwe: A Situational Analysis 33